1. Community
  2. Women's health
  3. Lichen Sclerosus

Pseudocystic smegma abcess

Posted , 6 users are following.

kb08194
kb08194

Hello. I am new to the group. I found your group when I was searcing for what is going on with me. I have had LS for about 6 years. All had been fine until the last few weeks. I have had a major flare up and now have a painful, tender, mobile, lump near my clitoris that seems to have stumped my doctor. It is not a cyst or lipoma. They seem to think it is an abcess, but hasn't quite presented itself as such on an ultrasound. I saw someone posted something about a pseudocystic smegma abcess on this board.  I watched the lecture by Dr. Goldstein linked to on this discussion  board and he mentioned it too; however, he didn't say too much about this. Can someone with experience with this tell me how it presented and how it was resolved? There just isn't much info out there about this problem. I appreciate any advice. Thank you so much!!!! 

3 likes, 19 replies

19 Replies

Next
  • Morrell1951
    Morrell1951 kb08194

    Edited

    That was me! I'll tell you the whole truth about how I feel it arose. My LS was flared up quite badly (I wasn't diagnosed, I had thought all this stuff was an aspect of psoriasis for 40 years). My inner labia were in the final stage of zipping closed over my clitoris. There grew a bit of a lump and without knowing the (very accurate) name of this problem, I gathered that smegma was collecting in this enclosure, so I was (foolishly) squeezing it out on a regualr basis, through the pinhole opening that remained. I figured because there was still an opening, there was a risk of infection. Finally, despite my attentions, one day it swelled up and the hole was shut. I put up with a painful spot for a day or two, but then it really swelled up and hurt all across my groin. Did I go to the doctor then? Nope. I squeesed the abscess and a scary amount of pus came out. Then I took myself to emergency, knowing that I would definitely need antibiotics ASAP. That was when the emergency doctor looked at my vulva and said, "You have quite a bit of atrophy there" and sent me to the gynaecologist who instantly diagnosed LS.

    If I had it to do over, I think it would have been safer to have the doctor lance the abscess. Dr. Goldstein didn't say much about it, but he did indicate it's a thing that happens. I believe my experience does a good job of explaining why it happens.

    The upshot is, yours is likely to get worse before it gets better. Do go to the doctor again if it swells up more.

    I'm so glad you posed this question!

    • j29188
      j29188 Morrell1951

      Posted

      When you say, "get worse before it gets better", does that mean there is a chance I can go back to being pain free again, once it closes up (assuming antibiotics work)? I am really hoping to avoid surgery and this gives me some hope. Thank you.

  • kb08194
    kb08194

    Posted

    Thank you for your response! I am so hoping this is what I have. The ultrasound looked like an abscess, but the radiologist said he couldn't rule out a neoplasm which I am assuming would mean cancer! It seems like the abscess is responding to antibiotics, but from the few articles I could find on this condition, it seems that having it excised is the only cure. Did you have yours excised, lanced, or just used antibiotics? 

    I had never heard of Dr. Goldstein. So glad I stumbled upon this board and his name. I have not been doing a good job of keeping my LS in check and it seems that is why I have this problem and could have many more problems in the future. His info about the cancer has scared me. When I was diagnosed my doctor did not mention a thing about cancer or increased risk!

    Thank you so much. This info has put my mind at ease a bit. The doctor said where I have my abscess is a strange place to have one, but I bet he hasn't worked with too many women that have LS. From what I have read about LS and other boards, and what DR. Goldstein said, it would seem to make sense that I have this smegmatic pseudocyst abcess. 

    • Morrell1951
      Morrell1951 kb08194

      Posted

      We won't get cancer. No worries at all. As long as you get checked out every year, there are plenty of early warning signs. Constant open wounds on untreated vulva are what cause trouble.

      I popped my abscess, bad thing to do, but same effect as lancing. I'm not any kind of medical person, so you need to trust the doctor as far as whether the antibiotics will kill the infection in there.

       

    • kb08194
      kb08194 Morrell1951

      Posted

      Thank you. I will find out Wednesday if they think the antibiotics worked. It seems as if they are working. The pain has subsided significantly, and I am only on day 3 of the antibiotics ( have to take it 7 days) . I will let the group know how this goes. Hopefully, I never get this again. I had never heard of smegma pseudocystic abscess, and I hope never have a thing like this again!
    • Morrell1951
      Morrell1951 kb08194

      Posted

      It sounds like the drugs are doing the trick. My theory is that this happens as the labia fuse while there's still a bit of an opening left so bacteria can get some oxygen. Once fusing is complete, what could get under there? It's kind of like once your ear piercings grow shut, there's no more guck...

      Not that we're happy to have this fusing happen, but this almost-done situation is rife with trouble, it seems.

    • Morrell1951
      Morrell1951 laura2218

      Posted

      Hi Laura, with twice-a-year checkups the doctors will catch any slight beginning of bad cells. Squamous cell carcinoma is relatively slow and curable. My mother has had it in two places (head and neck) and her doctors were in no hurry to cut it out. She had a festering spot on her neck for years and still it all came out fine. My sister had quite an extensive patch on her vulva after years of neglect (she just thought it was psoriasis) it was removed many years ago with no recurrence. The other thing is if we manage our LS well, we won't be constantly badly flared – it's a chronically irritated lesion that provides fertile ground for cancer. And we're checking ourselves in the mirror daily, so we'll notice the slightest change.

      If you watch Dr. Goldstein's presentation (on the list of links in the "New to LS - start here" discussion pinned at the top of this forum) you'll hear him say he has 1200 LS patients and the only one who's gotten cancer (statistically he should have dozens) is a woman who left his practice and her treatment for three years. When she came back she had cancer.

      Worry and stress are our enemies, so thinking this way is just one more positive thing we can do for ourselves.

  • kb08194
    kb08194

    Posted

    I went to the dr. yesterday. The lump is definitely smaller, but still there. It is no longer painful. I told him about Dr. Goldstein and the pseudosytic smegma abscess, and I think he thought I was crazy. He said that only happens with people with LS that is out of control (mine is not), but I don't think that is correct from what Dr. Goldstein said in the presentation. He hopes that the abscess will continue to get smaller; if it doesn't I will need to go back and maybe have it excised. What a mess!  Is there anything else anyone can suggest to get rid of this thing. I am just relieved that it is not cancer, but I don't want to go through the pain I just experienced. Thanks!
    • Morrell1951
      Morrell1951 kb08194

      Posted

      It sounds pretty good. Is it getting smaller because you're on antibiotics?

      I read a great article in Harpers that talked about the new way doctors diagnose. I forget what it's called, but it's flow chart thinking. They make one hypothesis and won't let go of it till they're sure they're wrong. The journalist highly recommended doing our own symptom searches. These new doctors are not Marcus Welby! My LS was not what anyone would have called 'out of control' – except an abscess and how is that not 'out of control'?

  • kb08194
    kb08194

    Edited

    Yes, I think the anitbiotics are helping the abscess shrink. I really thought he would drain it, but he didn't want to because of its location. I am also putting a hot pack on it 4 times a day. He seemed to think I would probably always have a little lump there and he mentioned that it could flare up again. I am really thinking I should have requested that it be excised. It sounds like trouble that will probably come back. 

    I think most doctors really don't know much about LS. It just isn't common to get an abscess in the area where I have it, but it is common for women with LS. I just really hope this thing doesn't flare up again.

    Have you ever gotten another abscess? Did your abscess completely go away after you popped it? 

    • Morrell1951
      Morrell1951 kb08194

      Edited

      I never got another after the course of antibiotics and I really believe this happens at the final stage of fusion when just enough oxygen gets in to feed bacteria. When I got it there was a visible 'seam' with a pinhole opening. After it healed the seam disappeared. I'm glad you've caught it before it burst.
    • Morrell1951
      Morrell1951

      Posted

      Having said that, I've had many like it in the crook of my groin, ever since I was a teen and I'm nearly 63. I think they were usually ingrown hairs. LS skin is just more prone... But I haven't had one in the year since my diagnosis and prescription for clobetasol.
    • k67167
      k67167 Morrell1951

      Edited

      i know this post is old, but wanting to reach out I have the exact same situation as Morelli19. My question is about the scarring, once the 'seam' closed fully and the little whole was not there, did you require surgery to release the adhesion? I was diagnosed about 5 months ago with LS, when i was referred to the gyne doc for this ?abscess/cyst? that my family doctor was not sure about. i have had 4 flare ups now of the cyst forming, draining through the little hole once it gets quite large. my doctor had mentioned doing surgery to remove the cyst and release the adhesion to expose my clitoris again. It makes me

      nervous to have surgery there and have worse scarring from the LS

    • j29188
      j29188 k67167

      Edited

      Hello. I have exactly the same question and am hoping that a previous poster will reply. I joined this forum just to reply to you, as I saw your post was only 7 weeks old. While waiting to see a gynae, the hole that I have left is getting smaller and smaller and I am very concerned about what happens next. It is reassuring to hear about antibiotics potentially being enough, as I had convinced myself that surgery was the only outcome... I would be very happy to not have surgery, as I have no issues with my clitoris otherwise - it works as it should - and I am afraid of worsening the LS (I am only 30 and have been mostly asymptomatic)! In fact, my whole life I didn't realise that my clitoris wasn't supposed to be buried under my skin and I didnt realise the hole should be there... I was never warned about fusion over the clitoris, when diagnosed with LS, and noone ever commented - I feel let down. I was prescribed some flucloxacillin by my GP but that wasn't enough - my guess is you would need stronger antibiotics? I'd be grateful for any reassurance from anyone on this thread. Thank you.

Back to top
Next

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.